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How increasing personal care service might delay or prevent nursing home placement
Sandra L. Spoelstra1, Charles W. Given2, Tracy DeKoekkoek3, Monica Schueller4
1PhD, RN Michigan State University College of Nursing 1355 Bogue Street, Room C342, East Lansing, MI, USA.
2PhD, Michigan State University Institute for Health Policy instead of Department of Family Medicine, B106 Clinical Center, East Lansing, MI, USA.
3RN, Michigan State University College of Nursing 1355 Bogue Street, Room C340L, East Lansing, MI, USA.
4BA, Michigan State University College of Nursing 1355 Bogue Street, Room C340N, East Lansing, MI, USA.

Article ID: 100001P16SS2014
doi:10.5348/p16-2014-2-OA-2

Address correspondence to:
Sandra Lee Spoelstra
Michigan State University College of Nursing instead of College of Human Medicine
1355 Bogue Street, Room C342
East Lansing, MI 48824
USA
Phone: (517) 353-8681
Email: spoelst5@msu.edu

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How to cite this article
Spoelstra SL, Given CW, DeKoekkoek T, Schueller M. How increasing personal care service might delay or prevent nursing home placement. Edorium J Public Health 2014;1:7–15.


Abstract
Introduction: There is a pressing need to retain dually eligible elderly Medicare and Medicaid beneficiaries in the community. The objective of this study was to examine median personal care services (PCS) hours, and how increasing PCS to the median (for those below), might delay nursing home placement (NHP) and save cost.
Methods: Retrospective study of PCS hours, costs, and NHP in a statewide home and community based waiver program in the Midwest serving 6525 dually eligible Medicare-Medicaid beneficiaries aged 65 and older. Two Minimum Data Set-Home Care assessments and Medicaid claim files were examined to identify PCS hours and cost. A model was developed to estimate costs of increasing PCS to the median to compare retaining at home compared to NHP.
Results: Participants with PCS greater than the median hours had a NHP rate of 25%, compared to 36% for those with less than median PCS hours. To attain a 25% NHP rate of participants below the median, we estimated savings by subtracting the usual monthly cost of the waiver ($960) from the monthly NHP cost and adding the cost of the additional PCS ($15.67/hour). For this sample, a total of $155,088 per month could be saved by adding PCS hours to the median.
Conclusion: The NHP rate could be reduced from 25–36%, and savings of nearly $2 million a year could be realized by increasing PCS hours to the median and retaining participants in the waiver program. Evaluating waiver participants who are below the median number and increasing those who need it could help retain participants in the home setting, where they most want to be, and allow for tremendous cost savings.

Keywords: Dually eligible, Home and Community-Based Waiver Program, Medicare and Medicaid, Nursing home placement, Personal care services

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Author Contributions:
Sandra L. Spoelstra – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Charles W. Given – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Tracy DeKoekkoek – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Monica Schueller – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2014 Sandra L. Spoelstra et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



About The Authors

Sandra L. Spoelstra is an Assistant Professor at Michigan State University College of Nursing, E. Lansing, MI, US. She earned PhD degree in Nursing from Michigan State University. Research interests include dissemination and implementation science in vulnerable disparate populations to delay or prevent nursing home placement. E-mail: spoelst5@msu.edu



Charles W. Given is Director of the Institute of Health Care Policy at Michigan State University, E. Lansing, MI, US.



Tracy DeKoekkoek is a doctoral student at Michigan State University College of Nursing focused on aging in place.



Monica Schueller is Project Manager at Michigan State University College of Nursing focused on promoting aging-in-place.




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